When the workplace is unsafe for health workers

There are many things that Kenyans would wish didn’t herald the start of 2024, including the increased cost of living, but none could be worse than the video that made rounds on social media of a young woman, at Port Victoria Sub-County Hospital in Busia County, harassing a nurse on duty.

This allegedly happened on December 31, 2023, where the said person was recorded hurling insults at the nurse while threatening to call a Cabinet Secretary. She raged on, letting out a string of expletives at the nurse, all the while kicking furniture, sweeping off the nurse’s tools and health records off to the floor. She did all, but physically assault the poor nurse.

All this went on with a shocked audience of vulnerable patients who were subjected to the profanities being let out. This woman was accompanied by a young man, who egged her on, while making calls to so-called important people. Off-screen, it is reported that the man drew a weapon to threaten the nurse, sending everyone into a panic as they fled.

What is so sad is that this is not a unique example of what goes on in public hospitals. Irrational next of kin have made it a sport to harass healthcare workers in public hospitals, both verbally and physically, without recourse. This seems to have gotten worse with devolution of health, where the “Mheshimiwas”, who commit the harassment in person or are used as a threat, are closer home.

Every health worker has a story. And it isn’t pretty. In early 2023, as part of routine inspections of referral hospitals around Kenya, where newly-graduated doctors are sent for internship, one of the facilities had a near-uproar as the young doctors protested the insecurity they were subjected to while working in the emergency department.

For these young doctors, the community they served is fairly hostile. They habitually take too long to seek medical help. This, coupled with issues of physical access to the health facility, means that a number of patients arrive when they are literally on their deathbed. These patients require aggressive measures to stabilise them before transferring them to the wards. This is where things go south. The relatives, who walk around armed with knives and simis as part of their cultural dress code, are not afraid to use their weapons to threaten the staff when the patient doesn’t fare well.

In several county hospitals, doctors and nurses have been threatened when local politicians want their next of kin prioritised for medical interventions such as surgery, just because of the connections. These politicians do not care that the condition of other patients may be more of a priority than theirs.

Even worse is when they expect the hospital to waive bills for people who surely have the capacity to pay. These are the same politicians who will sit at the assembly and refuse to allocate sufficient resources to run the county health facilities in the first place. Yet they want their friends and cronies to be given private rooms and they summon the doctors to the bedside to order them on how to do their jobs.

The repeated bad behaviour encourages those close to power to behave even worse in similar circumstances. If the young man and woman in the video are truly closely affiliated with the politician whose name they were invoking, it is safe to say that as a country, our healthcare workers are not safe.

What we fail to understand is that once the frontline workers are not safe, we have sentenced our patients to the deep end. No one wants to work in an unsafe work environment. It does not matter the profession or the work area. You would think we have learnt our lessons.

The Covid-19 pandemic left healthcare workers feeling extremely vulnerable. Countries like the United Kingdom and the United States had a mass exodus of nurses leaving the practice, remarkably threatening their numbers in the workforce. They are yet to recover. Now they are actively recruiting nurses from African countries like ours, to address the gap.

In Kenya, nurses are the very first line of defence in patient care. With every ambulance that pulls up or every car door yanked open outside the emergency department, nurses are the first to receive the patient. They are the ones who evaluate the patient’s condition and initiate resuscitative measures to keep the patient alive as they await the doctor’s assessment.

The moment we make their space unsafe, we are definitely telling them we don’t need them. We are telling them that they are indispensable and that they do not have to be there. All patients deserve to be treated by a workforce that feels safe and respected at the workplace.

Every workplace must have in place a risk assessment and risk mitigation policy for its workers. And all health workers must be made aware of their rights as they strive to deliver services. It nags me that for over three minutes, the violence went on unabated, with no institutional response. Does this hospital not have a security system in place?

Health workers have a right to refuse to provide care and transfer the patient to another facility or caregiver when they feel that the environment is not appropriate to deliver the service. Further, the first rule of patient care is that one must keep themselves safe first before they can save the patient. This was well demonstrated during the pandemic, where even if a patient were to code, the doctors and nurses had to fully gear up in their protective gear before attempting to approach the patient. This nurse had every right to remove herself from the scene until it was safe enough to allow her to continue providing care.

Condoning violence against health care workers is an attitude we must condemn in the strongest terms possible. We must not allow people with such callous attitudes and unacceptable behaviour to breach the labour laws and get away with it.

I also hope that politicians have the decency to stand up for the patients and health providers by dissociating themselves from such characters as these terror pair proved to be!

Dr Bosire is an obstetrician/ gynaecologist